Application Form for Association Membership (Please type or complete in black ink, using BLOCK LETTERS)
Name of Association/Organisation:___________________________________________________ ___________________________________________________ Date Founded:___________________________________________________
Permanent Address:___________________________________________________ ___________________________________________________ ___________________________________________________
Phone:___________________________________________________ Fax:___________________________________________________ Email:___________________________________________________
Name of President:___________________________________________________ Name of Vice President:___________________________________________________ Name of General Secretary:___________________________________________________
Membership open to:___________________________________________________ (i.e. Master Mariners only: Masters, Mates, Pilots)
Number of active serving Shipmasters (Afloat):___________________________________________________ Number of active Shipmasters (Ashore):___________________________________________________ (i.e. Marine Superintendents; Harbour Masters; Pilots; etc.)
Number of retired Shipmasters:___________________________________________________ (i.e. not in any form of gainful employment)
Number of other Members (not Shipmasters):___________________________________________________
Signature:___________________________________________________ (President) ___________________________________________________ (General Secretary) Date:___________________________________________________
( Please note: This form must be posted to IFSMA as your original signature is required ! )